October 10, 2014

Breakfast: One Way to Reduce Kids' Risk of Developing Diabetes

Eating a healthful breakfast is good for you for many reasons, and a new study says that for kids, this regular practice can reduce the risk of developing diabetes.

Type 1 diabetes, once referred to as “juvenile” diabetes, develops early in life as a chronic condition. The pancreas is unable to produce the hormone insulin, or sufficient amounts of it, to maintain a proper level of glucose, or blood sugar. The more common type 2 diabetes develops later in life, often with a significant contribution by unhealthful behaviors that encourage the body to become resistant to insulin.

According to a recent study published in PLoS Medicine, getting into the habit early in life of eating a healthful breakfast might help kids lower their risk of developing type 2 diabetes. In the study, children who skipped breakfast most days had higher levels of known diabetes risk factors.

More than 4,000 children ages 9 and 10 were studied. More than 1 in 4 said they did not eat breakfast every day. Their resistance to insulin, a marker for diabetes, was higher than those who said they ate breakfast every day.

The kind of breakfast was important, too. Kids who ate a high fiber cereal, or one composed of complex carbohydrates, showed a lower insulin resistance than the ones who ate a meal higher in simple carbohydrates, such as biscuits.

There are two kinds of carbohydrates: complex and simple. Complex carbs are more healthful because they are less refined and the body takes longer to digest them. That helps moderate glucose levels. Simple, or refined, carbohydrates are digested more quickly and can cause blood sugar to spike.

Whole grains, or complex carbs, have more dietary fiber and are found, for example, in whole wheat and whole oats. Simple carbs have more sugar, and, in addition to refined grains, are found in milk products and fruit. They can be part of a healthful diet, but refined sugar products — foods rich in white flour and added sugar — are not. So it’s better to sweeten your whole wheat flake cereal with fruit than white sugar.

Of course, a good breakfast also has some protein (eggs, for example), but this study focused on carbohydrates. And because it showed only an association, further studies are required to adjust for factors such as a child’s socioeconomic status, degree of physical activity and body fat in order to draw concrete conclusions.

But there’s no question oatmeal is a better breakfast choice than toast made from white bread. Anything that might stave off diabetes and its chronic complications is a good thing. (See our blog, “Teens Who Develop Diabetes Have a Stark Future.”

To learn more about carbohydrates, visit the information page on the website of the Centers for Disease Control and Prevention.

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September 19, 2014

CDC Says Kids Eat Too Much Salt

According to the U.S. Department of Agriculture’s dietary guidelines, children should consume no more than 2,300 mg of sodium every day. According to a new report by the CDC, they’re eating about 3,300 mg.

The risks of eating too much salt include high blood pressure, which can lead to stroke and heart disease later in life. And high-sodium foods often have a lot of calories, which undermines weight control.

American youngsters already show the effects of their salty diet. As federal officials said in a story on Reuters.com, 1 in 6 Americans 7 to 18 years old has elevated blood pressure, which is linked closely linked to a high sodium intake and obesity.

Most of the sodium kids eat comes from processed foods including pizza, sandwiches like cheeseburgers, cold cuts and cured meats, pasta with sauce, cheese, salty snacks like potato chips, chicken nuggets and patties, tacos and burritos, bread and soup.

"Most sodium is from processed and restaurant food, not the salt shaker," CDC Director Tom Frieden said in a statement. "Reducing sodium intake will help our children avoid tragic and expensive health problems."

According to the report, more than 9 in 10 U.S. kids between 6 and 18 years old eat too much sodium every day. Teenagers eat more salt than younger kids.

About 65% of their sodium consumption comes from foods purchased in stores; fast food restaurants account for about 13%. Meals provided at school represent 9% of total sodium consumption.

And if you think snacking, and food eaten outside of parental control, is the root of this evil, think again — dinner is the largest single source of sodium, accounting for nearly 40% of daily consumption.

The study involved the National Health and Nutrition Examination Survey in 2009 and 2010, and included interviews with more than 2,000 school-aged children.

Developing a taste for salty foods occurs early, so it’s important for parents to influence diet from a young age, and help their children develop a taste for less salty meals through what they buy, how they prepare it and by establishing healthful eating habits themselves.

As the researchers said, the need is to reduce sodium "across multiple foods, venues and eating occasions." In calling for processed foods with less sodium, they acknowledged that efforts in Britain to reduced total sodium consumption resulted in a 15% decline over seven years.

The CDC recommends that parents and caregivers:

  • Model healthful eating for their children by providing a diet rich in fruits and vegetables without added sodium.

  • Compare Nutrition Facts labels to choose the lowest sodium option before they buy.

  • Ask the grocery manager to provide more low sodium options for their family's favorite foods.

  • Request restaurant nutrition information to make lower sodium choices when dining out.

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June 27, 2014

New Rules Should Protect Quality of Baby Formula

Earlier this month, the FDA finalized new guidelines for manufacturers of infant formula in order to better protect babies from contaminated products. The move is a response to several prominent nationwide recalls of different formula products in the last several years.

As reported by MSN.com, in 2010, 5 million containers of Similac were recalled by Abbott Laboratories because they might have been contaminated by insect parts. In 2011, powdered versions of Enfamil, made by Mead Johnson Nutrition, were yanked from store shelves over concerns of contamination, which later proved unfounded.

Still, the red flag was raised, and now companies that make baby formula will be required to test for the presence of two kinds of bacteria, salmonella and cronobacter, that pose serious health risks to wee ones. They’ll also have to monitor their products for a longer period.

Salmonella can cause diarrhea and fever, sometimes to a life-threatening degree; cronobacter, which prefers dry environments such as powdered formula, can cause swelling of the brain — meningitis — in infants.

Most public health officials and medical professionals say breast milk is best for babies, but for various reasons of both necessity and convenience, many mothers don’t breast feed. So, many infants get all or part of their nutrition from formula.

Baby formula is not subject to FDA approval prior to sale. But all formula sold in the U.S. must meet federal nutrient requirements, and they do not change with the new regs. Infant formula manufacturers are required to register with FDA, and notify the agency before they market a new formula.

The FDA conducts yearly inspections of all facilities that manufacture infant formula. It collects and analyzes product samples, and inspects new facilities. If the feds determine that a formula presents a risk to human health, its manufacturer must conduct a recall.

The new requirements, according to the FDA, are meant to establish the "good manufacturing practices" that many companies voluntarily follow. These regulations establish federally enforceable standards for safety and quality.

They apply to formula sold "for use by healthy infants without unusual medical or dietary problems," said the FDA.

Under the new rules, companies must test their products' nutrient content and prove that the formulas can "support normal physical growth," the agency said. They must test the nutrient content in the final product stage, before entering the market and at the end of the products’ shelf life.

According to FDA, about 1 million U.S. infants are fed formula from birth; by the time they are three months old, about 2.7 million rely on formula for at least part of their nutrition.

Infant formula comes in three forms:

  • powder — the least expensive of the infant formulas, it must be mixed with water before feeding;

  • liquid concentrate — must be mixed with an equal amount of water;

  • ready-to-feed — the most expensive form of formula that requires no mixing.

The protein source varies among the different types of formula. The FDA’s nutrient specifications are set to meet the nutritional needs of average, healthy infants. Manufacturers use nutrient levels that usually exceed the FDA minimum. So babies fed infant formulas don’t need added nutrients unless they are fed a low-iron formula.

The formulas currently available in the U.S are either “iron-fortified” — with about 12 milligrams of iron per liter — or “low iron” — with about 2 milligrams of iron per liter. The American Academy of Pediatrics (AAP) recommends that formula-fed infants be fed iron-fortified formula to help reduce the prevalence of iron-deficiency anemia.

To learn more about safety and infant formula, such as proper storage, visit the FDA website. To learn more about childhood nutrition, see our blogs on the topic.

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September 13, 2013

Schools Are Better at Teaching Healthful Habits

Last month, the Centers for Disease Control and Prevention (CDC) released the results of a study about how well schools follow healthful policies and practices. And the news is good!

“Schools play a critical role in the health and well-being of our youth,” CDC Director Tom Frieden said in a news release about the School Health Policies and Practices Study (SHPPS). “[M]ore students have access to healthy food, better physical fitness activities through initiatives such as ‘Let’s Move,’ and campuses that are completely tobacco free.”

SHPPS is the largest, most comprehensive assessment of school health policies and practices in the U.S. It’s conducted at the state, district, school and classroom levels nationwide to assess these eight components at the elementary, middle, and high school levels:

  • health education

  • physical education and activity

  • health services

  • mental health and social services

  • nutrition services

  • healthy and safe school environment

  • faculty and staff health promotion

  • family and community involvement.

Some specific results of the study show that after years of efforts to phase out junk food, the ratio of school districts that prohibited it in vending machines increased from about 3 in 10 in 2006 to more than 4 in 10 last year. And slightly more than half of school districts — up from about 35 in 100 in 2000 — made information available to families on the nutrition and caloric content of foods available to students.

Between 2006 and 2012, the ratio of districts with food procurement contracts that addressed nutritional standards for foods that can be purchased separately from the school breakfast or lunch increased from 55 in 100 to more than 73 in 100.

In terms of physical education, since 2000, the ratio of school districts that require elementary schools to teach physical education increased from more than 8 in 10 to more than 9 in 10 in 2012. And 6 in 10 school districts partner with a public or private entity such as parks, recreation departments, the YMCA, Boys or Girls Clubs, or the Boy of Girl Scouts for shared use of school or community property.

The ratio of districts with policies that prohibited all tobacco use during any school-related activity increased from about 47 in 100 in 2000 to almost 68 in 100 in 2012.

SHPPS was conducted at all levels in 1994, 2000 and 2006. The 2012 study collected data only at the state and district levels. The school- and classroom-level data from SHPPS will be collected in 2014 and released in 2015.

For more information about SHPPS, link here.

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February 22, 2013

Fast Food Diet Shows Link to Breathing Problems

Parents generally don’t need a reason to limit their children’s consumption of fast food—everybody knows chicken nuggets, fries and bacon burgers are load with saturated and trans fats, which have been shown to compromise immunity. Now, a new study in the respiratory journal Thorax seems to show a direct cause-and-effect for specific harms of eating too much junk food.

As reported on ScienceDaily.com, the study results show that eating three or more servings of fast food each week is associated with a higher severity of allergic asthma, eczema (skin inflammation) and rhinitis (inflammation of nasal passages) for children in developed nations.

We’ve blogged about the respiratory signs of allergy.

Dietary data was collected from more than 319,000 13- and 14-year-old teens in 51 countries, and more than181,000 6- and 7-year-olds from 31 countries. All of the study’s subjects were involved in the International Study of Asthma and Allergies in Childhood (ISAAC), a collaborative research project involving more than 100 countries and nearly 2 million kids. ScienceDaily says it’s the largest study of its kind.

Parents of the kids were asked about symptoms of asthma (wheezing), rhinoconjunctivitis (runny or blocked nose accompanied by itchy and watery eyes) and eczema (patchy, itchy skin, bleeding blisters), and their weekly diet. They focused on the severity of symptoms over the last 12 months, including frequency and interference with daily life and/or sleep patterns. They also asked about certain foods linked to protective or damaging effects on health.

They included meat, fish, fruits and vegetables; cereals, bread, pasta and rice; butter and margarine; nuts; potatoes; milk; eggs; and fast food/burgers. They asked how often the children ate these foods—never, occasionally, once or twice a week and three or more times a week.

The analysis showed that fast food was the only food category to show the same associations across both age groups. So the authors suggested that "such consistency adds some weight to the possible causality of the relationship."

The study had limitations—relying on one’s memory isn’t the best way to collect objective data—but because the sample was so large and included so many regions, the patterns can’t be ignored.

The relationship between fast food and severity of symptoms for the three conditions was consistent among the teens in all the participating countries, irrespective of gender or family affluence.

The pattern among children was less clear-cut, but except for eczema, a fast food diet still was associated with symptoms across all regions and poorer countries, except for current/severe symptoms of asthma. (See our blog about the quality of hospital care for children with asthma.)

This difference, the authors speculated, might have to do with the fact that children have fewer options about their food choices.

Three or more weekly fast food servings were linked to an increase of severe asthma of more than one-third for teens and more than one-quarter for younger children.

But fruit seemed to be protective for both age groups in all regions for all three conditions among younger children, and for current and severe wheezing and rhinitis among the teens. Eating three or more servings of fruit each week was linked to decreased severity of symptoms for both teens and younger children.

Parents who eat healthfully model this habit for children, who will benefit from it their whole life. The occasional fast food meal is not a problem for most people, but if your child has respiratory problems, he or she might be more vulnerable to its negative effects.

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May 10, 2012

Teens Who Develop Diabetes Have a Stark Future

Youth often confers health benefits not available to adults. One example is metabolism—when you’re young, you burn calories faster than when you’ve stopped growing and age (among other factors) imposes a more sedentary existence. Another example is bone regeneration—younger folks build bone better and faster than their elders, and generally are not at risk of osteoporosis, a degenerative bone disorder.

But a new study signals that one dread disorder—diabetes—is as ominous for youngsters as it is for adults. A study and companion editorial in the New England Journal of Medicine made clear that if a teenager develops Type 2 diabetes, he or she will struggle for life to control it.

The problem is obesity. Thanks to poor diet and insufficient exercise, too many teenagers are overweight, concluded the largest federally funded study ever to examine how to treat diabetes in teens. (Earlier studies primarily focused on adults.)

Most diabetes drugs aren't approved for youths. So the key for kids is to prevent the disease, not to treat it.

As a story in the Associated Press pointed out, in earlier generations, doctors seldom saw children with Type 2 diabetes. (Type 1 diabetes, formerly called “juvenile diabetes,” presents earlier, and is attributed to both genetic risk and external factors, such as diet or an infection.)

One-third of U.S. children and teens are overweight or obese. They are at higher risk of developing Type 2 diabetes, in which the body either fails to make enough insulin or to use it efficiently to metabolize sugar from food.

Treatment for Type 2 diabetes usually is metformin, a drug to lower blood sugar. If that doesn’t control the problem, other drugs and daily insulin shots may be required. The risks of long-term blood sugar problems include blindness, nerve damage, kidney failure, limb amputation, heart attack and stroke.

Read more about diabetes and its standards of care here.

The study tested how to manage blood sugar in teens newly diagnosed with diabetes. Half of the nearly 700 subjects failed within a few years; 1 in 5 suffered serious complications.

The study subjects had their blood sugar normalized with metformin, then were given either metformin alone, metformin plus diet and exercise counseling or metformin plus a second drug, Avandia. After nearly four years, half of the metformin-only group failed to maintain blood sugar control. The group on two drugs did a little better, but not much different from those in the lifestyle group.

Because Avandia has been linked to a higher risk of heart attacks in adults (which became known after the study began), it’s not recommended for teens.

The NEJM editorial, by Dr. David Allen, called the study’s message “stark”: “[T]omorrow and beyond, public-policy approaches — sufficient economic incentives to produce and purchase healthy foods and to build safe environments that require physical movement — and not simply the prescription of more and better pills will be necessary to stem the epidemic of Type 2 diabetes and its associated morbidity.”

Yes, the problem is social. But it’s also individual. Parents must establish healthful eating habits early in life, and ensure that their children exercise their bodies as well as their minds. Those are the earliest, easiest and best interventions to prevent the insidious disease that robs so many people of so much, and many of them too soon.

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July 5, 2011

Good Oral Health Starts in Infancy

Pop quiz: Which of the following promote tooth decay?

(A). sugar;
(B). genetics;
(C). low immunity;
(D). watching "American Idol."

The correct answer, of course, is "all of the above" ... with a qualifier for (D). (You have to be snacking on Raisinettes or another sticky fruit while watching the show.)

Although sugar remains the primary suspect in the creation of cavities, people can be genetically disposed toward tooth decay, and low immune function can contribute, as can dietary habits generally considered healthful--sticky fruits such as raisins, although preferable to sucking on a Popsicle, also leave teeth vulnerable to the ravages of sugar residue.

So what can a concerned parent do?

It's hard enough for parents to control so many factors conspiring to turn their kids' mouths into a gaping maw of dental disaster, but now there's something else to consider. According to the Los Angeles Times, several studies have shown that cavity-causing bacteria can be passed from primary caregivers to wee ones.

Children are most susceptible as infants and toddlers, when their immune systems are works-in-progress. But any age before children have the motor skills necessary to brush well by themselves requires parental invervention for maximum protection.

If you want to hold the line on sharing the bacterial love that can compromise your child's oral health not only as a youngster but after the arrival of permanent teeth and into adulthood, first take care of yourself. Expectant mothers should address any dental decay or gum problems before Junior arrives to reduce the likelihood of transmitting disease. And the use of an antibacterial mouthwash during the lower-immune period of infancy and toddlerdom might be wise.

In addition, the dentist should become a close, personal friend of your child probably earlier than you expect. Measures you should take include:

  • schedule the first visit to a pediatric dentist at the time the first tooth appears or by the first birthday;

  • limit the contents of bottles and sippy cups to water except at mealtime;

  • limit snacking to a short interval--bacteria like any kind of sugar, whether from fruit, milk, honey or the refined white sugar in candy;

  • assist your child with tooth-brushing until he or she is old enough to tie shoes or write cursive--generally 7 to 9 years old.

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February 3, 2011

Caffeine-laced energy drinks worry researchers

A review of studies about the contents of energy beverages has raised serious questions about their efficacy and safety. The review, published in the November issue of the Mayo Clinic Proceedings, noted that the drinks contain high levels of caffeine and could pose dangerous, even life-threatening effects on blood pressure, heart rate and brain function to some susceptible individuals.

The study found four documented cases of caffeine-associated death and five separate cases of seizures associated with consumption of energy/power drinks. Other reports included: (1) an otherwise healthy 28-year-old man who suffered a cardiac arrest after a day of motocross racing; (2) a healthy 18-year-old man who died playing basketball after drinking two cans of Red Bull; and (3) four cases of mania experienced by individuals known to have bipolar disorder.

Noting that teens and young adults are consuming energy drinks “at an alarming rate,” the study authors said it was important to determine whether long-term use of these beverages “will translate into deleterious effects later,” such as liver and cardiovascular disease, insulin resistance and diabetes.

Currently, the drinks are labeled as “dietary supplements,” which exempts them from regulations governing sodas and juices and allows manufacturers to make “ “structure and function” claims, like “enhances athletic performance” and “increases caloric burn and mental sharpness.”

The American Beverage Association says most mainstream energy drink brands voluntarily put statements on their containers, including advisories about use by people sensitive to caffeine, and many also list the amount of caffeine on their product labels or have provided caffeine content information through their Web sites and consumer hot lines.

But the study authors worry that some athletes who exercise intensively are substituting energy drinks for sport drinks (which only contain sugar and electrolytes). They say the high doses of sugar in energy drinks can impair absorption of fluids and result in dehydration, noting that a 16-ounce can of an energy drink may contain 13 teaspoons of sugar and the amount of caffeine found in four or more colas.

Source: The New York Times

You can view an abstract of the study published in the Mayo Clinic Proceedings here.

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January 26, 2011

Is Michelle Obama responsible for pedestrian injuries?

Two officials from the Governors Highway Safety Association (GHSA) blamed First Lady Michelle Obama’s Let’s Move anti-obesity program for a small increase in pedestrian fatalities, then quickly backtracked after almost universal negative reaction to their remarks.

GHSA executive director Barbara Harsha told the Washington Examiner that “there is an emphasis these days to getting fit, and I think people doing that are more exposed to risk [of getting hit by a vehicle].” Another GHSA spokesman, Jonathan Adkins, told a local radio station that the First Lady is “trying to get us to walk to work and exercise a little bit more. While that's good, it also increases our exposure to risk.”

In 2010, 1,891 road deaths were recorded in the U.S., an increase of seven, or 0.2%, bucking a longterm downward trend. Harsha noted that “many factors” could be responsible for the small uptick, including increased use of iPhones, mp3 players and other devices that make pedestrians less aware of oncoming traffic.

The GHSA officials’ remarks were universally criticized, prompting quick retractions. Harsha later claimed she was misquoted and that the GHSA "in no way opposes Ms. Obama's program." Adkins now says he “did not blame Mrs. Obama for the small uptick in pedestrian deaths but simply noted that programs such as Mrs. Obama's may be increasing the number and frequency of pedestrians and thus exposing them to more risk.”

Sources: Washington Examiner and TheAtlanticWire

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June 22, 2010

Liquid Vitamin D: Too Much of a Good Thing for Babies

In a recent news release, FDA warns parents and caregivers of the risk of overdosing infants with liquid vitamin D. The liquid supplement is administered with droppers that are sold with the supplement itself. However, some of the droppers hold more vitamin D than is appropriate for babies.

Vitamin D supplements are recommended for some children to promote growth of healthy and strong bones. However, if fed with excessive amount of vitamin D, infants experience a myriad of symptoms ranging from nausea to muscle weakness, and sometimes even kidney damage.

Here are the FDA’s recommendations for parents whose children receive vitamin D supplements:

* Ensure that your infant does not receive more than 400 international units (IUs) of vitamin D a day, which is the daily dose of vitamin D supplement that the American Academy of Pediatrics recommends for breast-fed and partially breast-fed infants.
* Keep the vitamin D supplement product with its original package so that you and other caregivers can follow the instructions. Follow these instructions carefully so that you use the dropper correctly and give the right dose.
* Use only the dropper that comes with the product; it is manufactured specifically for that product. Do not use a dropper from another product.
* Ensure the dropper is marked so that the units of measure are clear and easy to understand. Also make sure that the units of measure correspond to those mentioned in the instructions.
* If you cannot clearly determine the dose of vitamin D delivered by the dropper, talk to a health care professional before giving the supplement to the infant.
* If your infant is being fully or partially fed with infant formula, check with your pediatrician or other health care professional before giving the child vitamin D supplements.

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March 31, 2009

Obesity Rate Higher in Schools Closer to Fast Food

A study that tracked millions of schoolchildren shows that children are more likely to be obese when their schools are close to a fast food joint, reports Roni Rabin of New York Times. The study is headed by economists at the University of California and Columbia University, and spanned almost a decade.

Enrico Moretti, one of the study’s authors, indicated that the study does not explain why students closer to a fast food restaurant are more likely to become obese, but affirmed the “credible and unbiased” causal effect it establishes between obesity and fast food.

Providing one more piece of evidence that fast food contributes to child obesity, this study has implications for public policy, said Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University. Neighborhoods and school district may choose to “zone out” fast food restaurants to protect their children’s health.

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October 2, 2008

Experts at Hopkins in Baltimore Recommend Labels for Energy Drinks for Kids

Caffeine is technically a drug, although it's hard to think of it like that.

But some experts are saying that, because caffeinated energy drinks promise some of the same effects as prescription drugs, they should be labeled so kids know that anything that produces those effects has to be treated with caution:

Because energy drinks are touted as performance enhancers and stimulants, Dr. Roland R. Griffiths explained in an interview with Reuters Health, kids who use them for these reasons will likely be more open to trying prescription drugs that promise the same effects.

"It seems like it's a pretty easy threshold to step over, but as a society we want to make this a bright line," Griffiths said in an interview.

In their report on the marketing, regulation and health effects of caffeinated energy drinks published this month in the journal Drug and Alcohol Dependence, Griffiths and his colleagues at The Johns Hopkins University School of Medicine call for regulations requiring energy drink makers to list the caffeine content of their products on their labels, and warn of the potential for caffeine intoxication.

The whole article merits reading as it contains a lot of little-known information about energy drinks and how they are manufactured and what they contain.

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July 15, 2008

Cholesterol Pills for Kids?

Recently, there was an outcry about new recommendations from the American Academy of Pediatrics that suggest giving kids as young as 8 years old cholesterol-reducing statin drugs.

Tara Parker-Pope discusses the controversy in a recent column. Those who object to the new recommendations worry about the drugs' long-term consequences, the AAP's financial relationships with drug companies and the possibility that the new guidelines will lead to overuse of the drugs. The defenders argue that the guidelines specify that only a very small group of children--those with strong genetic and lifestyle risk factors--would even be considered for statin therapy. Parker-Pope's whole article is worth reading, as it discusses both the financial and the medical aspects to this debate.

One problem here is widespread throughout medicine: what some have called "indication sprawl." Once a drug or treatment is recommended for one narrow category of patients, it tends to get indicated for more and more categories with less and less testing and justification for the new categories. But more profit for the drug makers.

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June 26, 2008

Parents File Suit Over BPA Bottles

This blog has previously discussed the dangers of bisphenol A (called BPA), a common ingredient in the plastics used to make baby bottles, for fetuses, babies and small children. The intended effect of BPA is to make the bottle shatterproof, which it does, but now evidence of its side-effects are coming to light.

Now four Ohio parents are filing a class-action suit against five baby-bottle manufacturers, alleging that the manufacturers knew about the dangers of BPA but continued to use it in their bottles anyway.

From the article:

The parents, all from Franklin County, sued Avent America of Bensenville, Ill.; Handi-Craft Co. of St. Louis, also known as Dr. Brown's; Evenflo Co. of Vandalia; Gerber Products Co. of Parsippany, N.J.; and Playtex Products of Westport, Conn., on behalf of themselves and others who bought the products.

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